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Clinical Examination of Shoulder Injuries

Examination Map HISTORY

Past Medical History

History of Present Condition

Mechanism of injury

Onset of symptoms

Location of pain

FUNCTIONAL ASSESSMENT

Athletic or Other Daily Tasks That Provoke

Symptoms

Throwing (as indicated)

INSPECTION

Inspection of the Anterior Structures

Level of the shoulders

Position of the head

Position of the arm

Contour of the clavicles

Acromion process

Deltoid muscle groups

Humerus

Inspection of the Posterior Structures

Vertebral column

Position of the scapula

Muscle development

Position of the humerus

Palpation

Palpation of the Anterior Structures

Jugular notch

Sternoclavicular joint

Clavicular shaft

Acromion process

Acromioclavicular joint

Coracoid process

Humeral head

Greater tuberosity

Lesser tuberosity

Bicipital groove

Humeral shaft

Pectoralis major

Pectoralis minor

Coracobrachialis

Deltoid muscle group

Biceps brachii

  • Long head

  • Short head

Palpation of the Posterior Structures

Spine of the scapula

Superior angle

Inferior angle

Rotator cuff

  • Infraspinatus

  • Teres minor

  • Supraspinatus

Teres major

Rhomboids

Levator scapulae

Trapezius

Latissimus dorsi

Posterior deltoid

Triceps brachii

JOINT AND MUSCLE FUNCTION ASSESSMENT

Goniometry

  • Flexion

  • Extension

  • Abduction

  • Internal rotation

  • External rotation

  • Horizontal abduction

  • Horizontal adduction

Active Range of Motion

Apley Scratch Test

Flexion/extension

Abduction/adduction

  • Drop arm test

Internal and external rotation

Horizontal adduction/abduction

Manual Muscle Tests

Gerber lift-off test

Flexion/extension

Abduction/adduction

Internal/external rotation

Horizontal abduction/adduction

Scapular muscles

  • Retraction and downward rotation

  • Retraction

  • Protraction and upward rotation

  • Depression and retraction

  • Elevation

Passive Range of Motion

Flexion

Extension

Abduction

Adduction

Internal rotation

External rotation

Horizontal abduction

Horizontal adduction

JOINT STABILITY TESTS

Joint Play Assessment

Sternoclavicular joint

Acromioclavicular joint

Glenohumeral joint

NEUROLOGICAL EXAMINATION

Upper Quarter Screen

VASCULAR EXAMINATION

Distal Pulses

Capillary Refill

REGION-SPECIFIC PATHOLOGIES AND SELECTIVE TISSUE TESTS

Sternoclavicular Joint

Acromioclavicular Joint

Acromioclavicular traction test

Acromioclavicular compression test

Glenohumeral Joint

Anterior instability

  • Apprehension test

  • Relocation test

  • Anterior release test

Posterior instability

  • Posterior apprehension test

  • Jerk test

Inferior instability

  • Sulcus sign

Multidirectional instability

Rotator Cuff Pathology

Impingement syndrome

  • Neer impingement test

  • Hawkins impingement test

  • Drop arm test

Rotator cuff tendinopathy

  • Empty can test

Subacromial Bursitis

Biceps Tendon Pathology

Bicipital tendinopathy

  • Yergason's test

  • Speed's test

SLAP lesions

  • Active compression test

  • Anterior slide test

  • Compression–rotation test

SLAP = superior labrum anterior to posterior

Inspection

FIGURE 12-1

(A) Anterior and (B) posterior view of the shoulders. Note that the shoulder of the dominant right arm hangs lower than the shoulder of the nondominant arm.

FIGURE 12-2

Scapular winging. (A) Posterior view. (B) Oblique view. In the presence of a weakened serratus anterior muscle, or long thoracic nerve injury, performing a "push-up" against a wall causes the vertebral border of the scapula to lift off the thorax.

FIGURE 12-3

Step deformity associated with an acromioclavicular joint sprain. (A) Gross inspection showing the rise in the distal clavicle. (B) Overlay showing the associated ligamentous trauma and associated structures. Depressing the distal clavicle and then releasing it ...

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